22 December 2016
How do you avoid horrible holiday heartburn?
It's no surprise that adverts for antacid tablets come into full swing at the same time as the Christmas festivities. For some people, heartburn is an unwelcome, but regular, visitor during the season of good will. Dr Mark Austin, consultant gastroenterologist at The Montefiore Hospital in Hove, explains how to reduce the symptoms and when to seek help.
With its excess of food and alcohol, the Christmas party season can bring on the symptoms of heartburn even for those who do not suffer for the rest of the year.
Pain behind the chest bone can be excruciating and is caused by acid going up into the oesophagus from the stomach. I have seen many patients who initially thought they were having a heart attack – only when this was ruled out did they discover it was heartburn.
Men are twice as likely to suffer than women, and being overweight can magnify the problem. With obesity on the rise, I have witnessed a 10% increase every year in the number of patients suffering with heartburn and indigestion problems.
Often, a couple of over-the-counter antacids, and a return to a normal diet, will see symptoms disappear. But for some people, heartburn is a regular occurrence, waking them up in the early hours of the morning and leaving them feeling exhausted during the day. Eating stops being a pleasure and they can feel nauseous. Some even find it hard to swallow.
If this is happening to you, most days, for three weeks or more, tell your doctor. Chances are it's nothing serious, but you're not wasting anyone's time by getting it checked out. Over time, the acid could damage the lining of the gullet, leaving it scarred. In some cases, this could lead to cellular change and cancer, so early detection makes it easier to treat.
But for many, antacids on prescription will be enough to calm the problem. If heartburn continues, then a referral to a specialist will be necessary. You will likely be referred for an endoscopy to check the health of the gullet and ensure there are no underlying conditions causing the heartburn. An endoscopy is a nonsurgical procedure, using a flexible tube with a light and camera, to examine the digestive tract.
If there are no underlying conditions, such as a hiatus hernia or cellular change indicating cancer, and no physical damage to the gullet, then, for most people, a course of medication and lifestyle advice will ensure symptoms reduce.
But there is a lot you can do to help yourself:
- Eat smaller meals more frequently throughout the day.
- Avoid eating large meals late at night.
- Reduce your intake of caffeine, nicotine and alcohol – these stimulants relax the lower end of the gullet muscle and increase the risk of heartburn.
- Do not lie down for two to three hours after a meal.
- Sleep with your pillows propped up.
- Lose weight if you are overweight or obese.
- Avoid increased pressure on your abdomen, such as from tight belts or doing sit-up exercises.
- If you suffer with heartburn, but can’t avoid eating a big meal late at night this Christmas, then take an over-the-counter antacid tablet as a preventive measure.
First published in Brighton and Hove Independent on 16 December 2016
18 November 2016
Keep an eye on your cough this winter
Here comes winter and almost everyone seems to have a cough!
But if your cough lasts for three weeks or more it could be something more serious than a 'bit of a cold'.
Now, as part of Lung Cancer Awareness Month, which runs throughout November, doctors are urging people to stop waiting for their cough to clear and get themselves to their GP. And if you smoke, you may cough more regularly, in which case, recognising a change in that cough is equally as important.
"A persistent cough could be a sign of an underlying disease, such as lung cancer, so the sooner it is detected and diagnosed the better the chances of treating it successfully," says Dr Sarah Doffman, respiratory consultant at Spire Montefiore Hospital in Hove. "There are many treatments available for lung cancer, and an increasing number of patients are cured completely."
In the Brighton and Hove area, around 180-200 new cases of lung cancer are diagnosed each year. Dr Doffman says campaigns to encourage to people to go to their GP with a persistent cough are helping the early detection of lung cancer, but are also unmasking other conditions such as emphysema, asthma and bronchiectasis – conditions which also benefit from early treatment.
While smoking is the main cause of lung cancer, around one in eight people with lung cancer have never smoked. It is important to look out for other tell-tale signs which include:
- Repeated chest infections
- Coughing up blood
- Feeling more tired than usual
- Losing weight for no obvious reason
- An ache or pain in your chest or shoulder
According to statistics released by Cancer Research UK, there were more than 45,000 new cases of lung cancer diagnosed in 2013, and in 2014 almost 36,000 people died from the disease. However, one and five-year survival rates for lung cancer have increased significantly, with new treatments becoming available at an ever-increasing rate, including the much-publicized use of targeted treatments.
In America, screening for lung cancer is now available, but such a measure has not been approved by NICE in the UK.
"In the US, screening has seen a 20% reduction in all-cause mortality rates and an improved survival from lung cancer which was diagnosed at an earlier stage. I hope that we will see screening for lung cancer implemented here in the UK one day soon," adds Dr Doffman. "However, until then, our best weapon in the fight, apart from prevention, is early detection, and that depends on people reacting to symptoms such as a persistent cough. You won't be wasting anyone's time and it could help save your life."
First published in Brighton and Hove Independent on 14 November 2016
9 November 2016
‘Dr Diabetes’ joins Hove hospital
A diabetes specialist is offering patients advice and the most up-to-date treatment at a private hospital in Hove. Sunil Zachariah 43, has joined the Montefiore Hospital, in Hove, as obesity and, with it, the prevalence of type 2 diabetes increases in the Brighton and Hove area.
More than four in ten adults in Brighton and Hove are overweight or obese, according to the Active People Survey, with more than one in ten classed as obese.
And an estimated 18,000 patients over 16 who are registered with a GP (general practitioner) in Brighton and Hove have type 2 diabetes.
The condition occurs when the body is not making enough insulin – or the insulin that it is making is not being used properly.
It usually appears in people in middle aged or older – and Dr Zachariah has already noticed a higher prevalence among the pockets of retirement homes in the local area.
Dr Zachariah said: “Type 2 diabetes is definitely going to increase here if you factor in the numbers of people who are severely overweight as this is the main risk factor.
“It can be managed with the latest drugs but advice on lifestyle changes is very important in treating patients.”
“It’s crucial they are treated properly as they are at a greater risk of a range of chronic health conditions, including cardiovascular disease, blindness, amputation, kidney disease and depression, than people without diabetes.”
Shortly after joining the Montefiore Hospital as the area’s only private endocrinologist, Dr Zachariah was warmly welcomed by 25 local family doctors when he led an education evening on diabetes.
In feedback after the event, the GPs that said they had better knowledge of treatments available and were more informed about diabetes, thanks to the consultant’s talk.
Dr Zachariah is an endocrinologist – an expert in hormones and glands. As well as diabetes, he will help patients with thyroid problems, adrenal lesions, obesity, polycystic ovaries and chronic fatigue.
The 43-year-old has been a doctor for the past 20 years, specialising in endocrinology since 2008. He lives in Sussex with his wife, Indu Koshi, who is also a doctor, specialising in acute medicine and geriatrics, and his 18-year-old son, who hopes to study medicine at university.
Dr Zachariah is currently running clinics on alternate Saturdays at the Montefiore Hospital, in Montefiore Road, Hove, but he expects this to become weekly by the end of this year.
The hospital, which opened four years ago in the old Legal and General offices and Hanningtons furniture depository, is owned by Spire Healthcare.
First published in Brighton and Hove News on 9 October 2016
29 July 2016
Q&A with the experts
Mike O’Connell is a consultant Ear, Nose & Throat Surgeon who specialises in nasal conditions, sinusitis, cosmetic nose and ear surgery but also many general conditions.
“My nose gets blocked!”
Nose blockage is a common problem and can occur for a variety of reasons. Hay fever or allergic rhinitis are common reasons and may be accompanied by itching, sneezing and watering. Other forms of irritation result primarily in blockage and nasal drip. Trauma can obviously cause problems and sinus conditions such as nasal polyps cause gradual increasing difficulty in nose breathing.
How do I resolve this problem?
The first thing to do is to see your GP who can make an assessment and advise on treatment. Topical nose sprays are very effective in many patients and safe. A proportion of people will not respond to such treatment and specialist advice should be requested. More thorough assessments with specialised equipment and scanning provide detailed information of the underlying problems, enabling accurate diagnosis and pointing to the correct treatment.
What else can be done for my blocked nose?
In appropriate patients, surgery can provide significant benefit. Repair of a deviated septum with the operation of septoplasty is a straightforward, quick operation that provides excellent results. Sometimes sinus procedures are needed including removal of polyps. Endoscopic sinus procedures are an effective means of resolving sinus inflammation and provide excellent outcomes for nasal blockage and congestion. A new technique of balloon sinuplasty offers a much less invasive and safer means of opening and draining sinuses. Recovery is quick, about 5-7 days and surgery is sore rather than painful. Usually medication is required to help the sinuses fully settle.
8 July 2016
Positive patient experience of ‘single dose’ radiotherapy for early stage breast cancer
In the South East of England, a patient experience study of 18 early stage cancer patients who opted for single dose intraoperative radiotherapy (IORT), found positive patient reported outcomes for this alternative to standard daily external beam radiotherapy (EBRT).
All participants felt well supported through treatment decision making and patients reported less pain than anticipated. After one month, 89 per cent of patients rated their recovery as good, very good or excellent and 84 per cent returned to full daily activities within four weeks of IORT treatment. The study was conducted at the Spire Montefiore Hospital in Hove.
For appropriate early stage breast cancer patients only, the ‘single dose’ radiotherapy option can eliminate the need for EBRT, which is typically administered five days a week, over the course of three to five weeks. IORT is administered at the time of surgery immediately after the tumour is removed.
Dr Charles Zammit, Consultant Breast and Endocrine Surgeon, and Honorary Senior Lecturer at Brighton and Sussex Medical School, led the study, and said: “The South East is leading the way in the UK with this ‘single dose’ radiotherapy option for early stage breast cancer patients. The study we conducted among our patients at the Spire Montefiore Hospital, demonstrates that women who choose single doe IORT report a positive treatment experience with many returning to normal daily activities very quickly.”
IORT is administered at the point of surgery and can have appositive impact on quality of life, patient satisfaction and convenience. However, despite an initial positive response by NHS England, IORT is not yet routinely available in the UK.
Dr Richard Simcock, Consultant Clinical Oncologist, Sussex Cancer Centre said, “Patients should have the option to choose the radiotherapy that is right for them. All too often treatment experience is overlooked or not deemed important. Breast cancer patients should be able to make an informed choice on the course of treatment they would prefer, particularly after an often traumatic diagnosis.”
IORT is not currently available on the NHS. NHS England has decided to wait until more clinical trial data becomes available before making decision on commissioning.
1 July 2016
Difficult to discuss
Tony Miles, a Consultant General Surgeon who specializes in colorectal surgery, talks about a problem many people find difficult to discuss.
I’ve had some rectal bleeding, what should I do?
Rectal bleeding is one of the most common complaints that come to my clinic. For most people rectal bleeding is innocent, nothing more than haemorrhoids. Unfortunately in a small number of patients it can indicate something more. The thing to remember is that the investigations for rectal bleeding whilst a bit embarrassing and a little bit uncomfortable, are very safe. It’s much “safer” to be investigated than leave things and take a risk.
If you are under 40 a flexible sigmoidoscopy (passing a small flexible telescope through the rectum into the lower1/3 of the colon) is often done to be sure that there are no problems. In patients over 40 with rectal bleeding and a change to a more frequent stool a full colonoscopy (inspecting the whole colon) is usually performed although some surgeons prefer just to do a flexible sigmoidoscopy. Patients over 60 with either bleeding or a change to a looser stool for more than 2 weeks should have either a colonoscopy or if that is not possible a CT cologram. Patients with unexplained abdominal pain or a lump to feel in the abdomen should have a CT. Finally patients who have unexplained anaemia should be investigated by a camera passed in to the stomach and the colon.
Is the risk the same for all age groups?
No the risks, in terms of cancer, are much lower in young people, although young people can have other problems such as colitis or fissures. Colon cancer is very rare in people under 40 and rare in people between 40 and 60. From 60 onwards it becomes more common.
What about screening for bowel cancer?
Colonoscopy is the most effective method of detecting colon cancer, but it is not practical to colonoscope everybody. The government has decided to offer everybody a single Flexible Sigmoidoscopy when they are 55. This is a simple investigation undertaken with minimal preparation; it takes about 10 minutes and does not need any sedation. A full colonoscopy however has been shown to be more effective in reducing overall risk. The government also offers Stool testing from age 60, this can indicate those people who are at higher risk of developing cancer and so should have a colonoscopy. The government screening program can reduce your risk by about 20%. More intense screening involving regular colonoscopy, flexible sigmoidoscopy and stool testing can reduce risk by up to 80%.
Tony Miles, a Consultant General Surgeon offers private consultations at The Montefiore Hospital, Hove. Mr Miles specialises in colorectal surgery. To book an appointment, call 01273 828 148 or email email@example.com.
10 June 2016
A common problem that can affect us all
What is a hernia?
Hernias are lumps commonly around your abdomen and groin areas caused by a weakness of muscles and protrusion of the body's internal contents. Left to their own devices hernias can cause pain, aches, discomfort, get big and become unsightly. In rare cases, they can also cause severe pain and strangulation of bowel if it gets trapped into the hernia defect - requiring emergency surgery.
What should you do if you think you have a hernia?
If you notice any unusual lumps or bumps about your body then get in touch with a Doctor. Once a hernia has been diagnosed and other conditions excluded, then surgery needs to be considered. Make an appointment with a Consultant Surgeon to discuss your options.
What’s your best treatment option?
Laparoscopic (also known as key-hole) surgery achieves safe day case surgery with low complications and very tiny 1cm scars. Laparoscopic surgery usually allows early return to daily activities and normal function. Even though a general anaesthetic is required for the surgery, it is also ideal for day case surgery - getting you back home as soon as possible. Longer term recovery and a return to sports and daily activities is speedier following this type of surgery.
Early diagnosis is the key so get any lumps or bumps looked at by a surgeon as early treatment for hernias with laparoscopic surgery is always the best option!
Mr Goldie Khera, a Consultant General Surgeon offers private consultations at The Montefiore Hospital, Hove. Mr Khera specialises in Laparoscopic (key-hole) Upper GI and weight loss surgery. To book an appointment, call 01273 828 148 or email firstname.lastname@example.org.